First started in the 1970s, urgent care clinics have become increasingly popular because they offer people convenient access to medical care, often on a walk-in basis. Today, there are more than 17,000 urgent care clinics in the U.S. Although these centers can respond to many immediate medical needs, there are times when you should go to a hospital emergency room instead. "The main reason to go to the emergency room is if the condition is potentially life-threatening," says Kelly Miller, M.D., family medicine practitioner and urgent care physician at the Washington Clinics in Fremont and Union City. Dr. Miller has worked in urgent care for the past 16 years. "Another reason to go to the ER is if the condition requires a test or treatment that is only available at the hospital," she adds.

Going to the ERTops on the list of conditions that require emergency room care is stroke. When a stroke occurs, treatment should be given within the first three hours after symptoms begin. This will greatly increase a person's chances of survival and rehabilitation. To better enable members of the community to protect themselves against the risks of stroke, The Stroke Program at Washington Hospital offers an innovative approach to treating stroke patients, using the latest technology combined with patient and community education to prevent the debilitating effects of stroke. To learn more about the Stroke Program, visit www.whhs.com, click on "Taylor McAdam Bell Neuroscience Institute" and select "Stroke Program" from the drop-down menu.

Heart attack is another reason to go to the emergency room. "Recognizing the symptoms of a heart attack can be tricky because chest pain does not always signal a heart attack," explains Dr. Miller. "If you are experiencing chest pain or pressure that makes you stop what you are doing, sit down and rest to catch your breath, especially if it is associated with a feeling of passing out or an irregular heartbeat, you should go to the ER immediately."

Other conditions best treated in an emergency room include:* A head injury involving loss of consciousness. This will require a CT scan, which is not available in an urgent care clinic.

* Respiratory problems in a person who has lung disease, such as chronic obstructive pulmonary disease (COPD) or emphysema. To assess these conditions, the physician will need to order certain blood tests performed at the hospital. This situation does not necessarily apply to people with asthma."If someone has previously had an asthma attack so severe they were admitted to the hospital, then it's best that they go to the emergency room if they experience another attack," recommends Dr. Miller.

* Blood clot, which is often signaled by pain and swelling in the leg, usually in the calf.

* Dehydration in a child or elderly person. When they are dehydrated, youngsters and the elderly need the electrolytes in their blood watches more carefully; and this should be done at the hospital. Electrolytes affect the amount of water in the body. Adults with dehydration can be treated in urgent care.

* Miscarriage.

Choosing Urgent Care For most other conditions that are not life-threatening, but need immediate treatment, you can go to urgent care. "This includes anything the patient is worried about," says Dr. Miller. "It is always appropriate to see a doctor when you are worried." Follow these basic principles so you'll get the right care at the right place:

* If you have a primary care physician, always call your doctor first. "The most common mistake people make is they assume they can't get care from their own doctor because the office is busy or closed," adds Dr. Miller. "Many times, problems can be handled over the phone. If the doctor is out of town, there's usually another physician who is covering. In these cases, when a doctor advises over the phone that you should go to urgent care, we are happy to treat you."

* If you have insurance but don't have a primary care physician, get one. In the long term, by establishing a relationship with a physician, you will receive better care, according to Dr. Miller.

* If you need to refill a prescription, this should be handled by the doctor who originally prescribed the medication. You can usually have your refill ordered by phone.

* If you are having a complication from surgery or another procedure, you should contact the doctor who performed the procedure. This will ensure that you get the best possible care.

* Urgent care is the appropriate place for treatment of lacerations and broken bones.

* Lastly, urgent care is not the appropriate place for elective procedures, like the removal of warts or other cosmetic needs.

Debuting this month on InHealth, a Washington Hospital ChannelInside Washington Hospital: Emergency Room will take an inside look at how Washington Hospital's team of emergency room physicians and nurses assess and treat patients when they arrive at the ER. InHealth broadcasts throughout Fremont, Newark and Union City on Comcast Channel 78. Send your questions and comments to InHealth@whhs.com.